Novel surveillance of Salmonella enterica serotype Heidelberg epidemics in a closed community.

Pathogen and disease surveillance and control represent important public health priorities in high-density and high-risk populations such as nursing homes, cruise ships, military bases, hospitals, and prisons. Reportable disease investigations, along with syndromic surveillance, have been used to identify and characterize outbreaks in their early stages. In this study, we provide evidence that ongoing wastewater monitoring could be used to supplement these traditional methods in at-risk closed communities. During 2003-2005, a systematic and regularly timed human and farm-animal wastewater sampling scheme existed in several geographically distinct locations of a multisite population in Texas. In early July 2003, an outbreak of gastroenteritis caused by Salmonella enterica serotype Heidelberg occurred in the human population at one site. Wastewater samples from the weeks before, during, and after the outbreak were tested for the pathogen. Selective culture, serogrouping, and serotyping techniques as well as real-time polymerase chain reaction and pulsed field gel electrophoresis were used to detect and characterize the Salmonella Heidelberg in each sample. The ability to detect the causative pathogen of an outbreak while it circulates in the host populations prior to and after an outbreak, as well as during the outbreak peak, suggests that wastewater could be used as a supplemental disease surveillance tool. To further explore this possibility, two subsequent outbreaks of uncharacterized gastroenteritis in additional locations were also investigated using wastewater samples.